Big Brother Is Already in the Consulting Room

Yesterday I received a letter from a Dr. Paul Soloman, who signed himself the National Medical Director of United Healthcare, the insurance company that oversees the AARP Medicare Supplement Insurance plan. And though I am a member of the AARP plan, the letter from Dr. Soloman came completely from out of the blue.

The letter's opening worried me. It said that taking care of my health, and especially managing all the day-to-day details, was hard...but they, United Healthcare, are here to help. Naturally, I breathed a sigh of relief.

"Because your health plan has access to your claims information, we're able to see the 'big picture' of your health." Well, I guess I felt pretty lucky to have someone watching the "big picture" of my health, although I was a little worried at the idea that there was an uninvited, unaccountable, doubtfully qualified "we" somewhere in the bureaucratic health universe who is privy to my most personal data. But heck, I thought, they seem to be working so hard on my case. The letter went on: "Several opportunities have been identified that may be worth talking to your physician about, at your next appointment."

Gee, that's good, I thought. Maybe Dr. P is really pretty busy these days and doesn't have the time to check out these "opportunities." I read on:

"Health Opportunity #1: According to medical evidence, people with heart failure may benefit from an ACE inhibitor." Gosh! I've been seeing Dr. P -- an internist and eminent cardiologist -- for fifteen or twenty years, and he never mentioned anything about heart failure or ACE inhibitors (medications that widen the arteries for people with high blood pressure).

What's wrong with that guy? Maybe I should see some other doc..someone who's more in touch with the "big picture" of my health.

The letter went on: "Our records suggest that you're not taking this type of medication. ... Be sure to ask your doctor at your next appointment: 1. Should I be taking this medication? 2. If not, what are the reasons?"

Next appointment? Hell, I thought, I'm not waiting three months for my next appointment with heart failure staring me in the face. I'll call right now for an appointment and get those ACE inhibitors working right away. Thanks, United Healthcare.

The truth is that when I got over my rage at this unbidden intrusion into my personal life, I reflected on how unmedical, unethical, and downright counterproductive this attempt at third-party control of health is. Firstly, contrary to United Healthcare's opinion, I do not suffer from heart failure or high blood pressure, and if I weren't a retired physician knowledgeable about such matters, I probably would have been pretty upset to have this suggestion made out of the blue. Secondly, the robodoc computer that came up with my "diagnosis" and treatment was working on the basis of a tiny fragment of my health data, making it virtually impossible to infer any valid conclusion about the state of my health.

Thirdly, this kind of intrusion can only undermine a patient's trust in his physician and make for complications that will cost the doctor many hours of explaining and reassuring with regards to the care of his patients.

Where the authority came from to allow United Healthcare to intervene in my case I do not know, but if the centralized power in play here is not curtailed, it can only get worse.

Fair warning!

-Yale Kramer, M.D.

Yesterday I received a letter from a Dr. Paul Soloman, who signed himself the National Medical Director of United Healthcare, the insurance company that oversees the AARP Medicare Supplement Insurance plan. And though I am a member of the AARP plan, the letter from Dr. Soloman came completely from out of the blue.

The letter's opening worried me. It said that taking care of my health, and especially managing all the day-to-day details, was hard...but they, United Healthcare, are here to help. Naturally, I breathed a sigh of relief.

"Because your health plan has access to your claims information, we're able to see the 'big picture' of your health." Well, I guess I felt pretty lucky to have someone watching the "big picture" of my health, although I was a little worried at the idea that there was an uninvited, unaccountable, doubtfully qualified "we" somewhere in the bureaucratic health universe who is privy to my most personal data. But heck, I thought, they seem to be working so hard on my case. The letter went on: "Several opportunities have been identified that may be worth talking to your physician about, at your next appointment."

Gee, that's good, I thought. Maybe Dr. P is really pretty busy these days and doesn't have the time to check out these "opportunities." I read on:

"Health Opportunity #1: According to medical evidence, people with heart failure may benefit from an ACE inhibitor." Gosh! I've been seeing Dr. P -- an internist and eminent cardiologist -- for fifteen or twenty years, and he never mentioned anything about heart failure or ACE inhibitors (medications that widen the arteries for people with high blood pressure).

What's wrong with that guy? Maybe I should see some other doc..someone who's more in touch with the "big picture" of my health.

The letter went on: "Our records suggest that you're not taking this type of medication. ... Be sure to ask your doctor at your next appointment: 1. Should I be taking this medication? 2. If not, what are the reasons?"

Next appointment? Hell, I thought, I'm not waiting three months for my next appointment with heart failure staring me in the face. I'll call right now for an appointment and get those ACE inhibitors working right away. Thanks, United Healthcare.

The truth is that when I got over my rage at this unbidden intrusion into my personal life, I reflected on how unmedical, unethical, and downright counterproductive this attempt at third-party control of health is. Firstly, contrary to United Healthcare's opinion, I do not suffer from heart failure or high blood pressure, and if I weren't a retired physician knowledgeable about such matters, I probably would have been pretty upset to have this suggestion made out of the blue. Secondly, the robodoc computer that came up with my "diagnosis" and treatment was working on the basis of a tiny fragment of my health data, making it virtually impossible to infer any valid conclusion about the state of my health.

Thirdly, this kind of intrusion can only undermine a patient's trust in his physician and make for complications that will cost the doctor many hours of explaining and reassuring with regards to the care of his patients.

Where the authority came from to allow United Healthcare to intervene in my case I do not know, but if the centralized power in play here is not curtailed, it can only get worse.